ReSurge International Blog

An Emotional Return to Dehradun

Dehradun, India – By Nisha Chaudry, ReSurge volunteer coordinator/translator

I’ve been looking forward to returning to Dehradun because I would finally get the opportunity to revisit the patients our team treated in 2009. I have often wondered how our former patients’ lives were changed after our visit. 

On clinic day, many of those patients returned to share with us how they are doing now. It’s been comforting to see how much happier and confident they are today.

After my first trip to Dehradun, I didn’t fully understand how the surgeries our team  provided would make a difference. Four years later, seeing the impact of those surgeries has been immensely gratifying.

One of the patients I met again yesterday was Prachi. In 2009 our team operated on Prachi’s legs, they had become fused together due to a burn contracture. Back then, Prachi couldn’t do the most basic tasks: like walk, attend school and play with her peers. One surgery completely changed her life.

Today, Prachi goes to school and actively participates in sports. It’s unbelievable how one procedure changed the trajectory of her life. When I first saw Prachi again we both hugged and we instantly started crying together. I think all the emotions we shared four years ago were present in our hearts. The pain she was living in when I first met her, the anxiety of her surgery, the frustration of the healing process and the joy of her first steps after surgery—it all rushed back to us. Now, four years later, we were meeting again. Prachi was in a better place physically, emotionally and all we could do was cry.  

After talking to a few of our former patients, I couldn’t help but notice how much happier they all appear. It’s been nice to see how they are all looking forward to living out their lives.

I am leaving Dehradun knowing that we do more than just repair bodies; we truly heal our patients at an emotional level. We are making a lasting impact in their lives and I am thankful to be a part of it all. 

Photo by John Urban of Nisha Chaudry and Prachi.

A Meaningful Day

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

Today was a particularly special day here in Dehradun. Every day at work, back in California, I look at pictures of our patients and read their stories. I know all their names and faces. So being here and meeting some of our patients is my equivalent of meeting a celebrity that I've been admiring from afar.

Today, I got to spend time with two of my "celebrities." Priyanka (pictured left) and Mamta (pictured right).

I first meet them last week at clinic day and I said hi as if I'd known them for years. I'm sure they were wondering why I knew their name and was acting so friendly.

Today, we took pictures of them and some video footage to show their progress. By the end of the day we had become friends. Both at some point or another gave me a hug or held my hand.

During the day I was particularly worried about Mamta, she seemed nervous and kept making a funny noise every time I asked her to sit in front of the camera. I was really concerned I was making her uncomfortable, so I had the translator ask her if she was OK. After the translator asked her, Mamta ran over to me and in English said: "No, I am very happy!" She was actually thrilled and I felt so indebted to her for allowing me to tell her story while making her feel special—because she is.

Priyanka has an amazing smile and a soft voice that melts your heart. The first time she received surgery, her dad carried her in his arms through the snow to get her treatment. At the end of today, she gave me a huge hug and asked me to visit her village next time I'm in India. I promised to do so.

Right before my car was leaving after the shoot, Priyanka came up to my window and wanted to hand me a rupee coin, the only money she had on her, to show me how much she cared. I said no and asked her to keep it for later. While I was waiting for the driver she ran to the store and came back with a piece of bubble gum she bought with her coin to give me instead. I couldn't deny her. All I had to give her in return was a pack of Tic Tacs.

On every trip I've ever been on I never feel like I give back enough. I keep on receiving and always look around at what I have, the laptop, the iPhone the camera in my bag and it just doesn't feel like enough to show the patients I meet how much their stories mean to me and how badly I wish I could do more. Priyanka and Mamta made my day feel more meaningful and for that I can't thank them enough. 

Photo by John Urban. 

Conquering the Unexpected: Bring Duct-tape and Isoflurane

Cao Lanh, Vietnam -- Reported by Mike Flynn, ReSurge medical volunteer

 

With patient safety a top priority, ReSurge has numerous strict protocols and quality measures.  It even has a series of emergency scenarios each medical team practices prior to operating – in case something goes wrong, like a loss of power in the operating theater.  Planning for the “what ifs” is good practice when working in the developing world.   But still, the unexpected can come, like last week in Cao Lanh, Vietnam.  

New Emergency Scenario #43: Snakes in the Operating Room (OR).

Have on hand: duct-tape, a blunt object, and extra isoflurane available to anesthetize the snake. Cameras to prove that it happened helpful, but not critical.

“Now I have seen it all,” said experienced volunteer anesthesiologist Mike Flynn.

“A three-foot long green snake came into the OR from a tiny gap in the window, where we were exhausting our anesthetic gases. It jumped down onto the window ledge, about six inches from the anesthesiologist’s head,” Mike reported. 

“Nurse Judi Eng was the first to see the snake and alarmingly pointed to the snake by anesthesiologist Jim Anania’s head. Jim turned, the snake jumped onto the floor next to him and slithered behind our big oxygen tank at the back of the anesthesia machine. This all occurred with a patient asleep and ready for a 2-hour palate surgery, with gag in place and surgeon scrubbed.

“So we called for help,” continued Mike. “A person with an absolutely useless metal stick arrived and tried to kill it. The snake went behind supply boxes and sent everybody scrambling away when it came out and started heading for the corridor between the two ORs. It then went under the operating table – with the patient still asleep on the table.  The surgeon decided to continue the surgery because no other room was available.  To secure the snake, Jim duck taped all around the base of the table. I cleared the room of all boxes and we planned to send the hospital snake catcher in as soon as the case was over.”

“Two hours later, the official hospital snake catcher arrived with an even smaller stick,” said Mike.  “But the snake catcher did not kill the snake.  Jim did -- by poring liquid isoflurane (an anesthetic gas) into the base of the duct-tapped OR table, stunning the beast and then applying blunt trauma when it came out later in a stupor.”

“Both operations were successful,” concluded Mike very thankfully, as it turned out that the snake was a poisonous juvenile green pit viper.

The Character and Spirit of Hasan

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

Hasan is a daughter, a sister, a mother and at the moment, a patient. Hasan’s smile is a clear window into her strong spirit, but her scars tell a different story.

Three years ago, after a family dispute over her dowry, Hasan’s husband and brother-in-law threw gasoline over her and set her on fire. Despite her burns, Hasan survived.

Today, Hasan is safely living in her parent’s home. Yet, her burn contractures have left her unable to move her neck and arms. She traveled a long way to see our team.

“People in my village told me not to come, they are scared to leave the village,” she said. “I’m not scared, I want to get my neck fixed,” she continued.

While our surgeons masterfully released Hasan’s contractures, I was overwhelmed by the thought that Hasan’s life could very well have been mine. I was born three years before Hasan and while at 25 I was pursuing my dream of working for an international NGO, Hasan was living a very different life. I feel grateful for my life but more so I feel a responsibility to do more for others whose reality is vastly different from mine.

“Did you do my surgery?” asked Hasan as she woke from anesthesia.

“Yes,” replied Nisha, our translator.  

“I had a dream that I was rejected for surgery,” continued Hasan. “Did you release my contractures?” she inquired.

“Yes, we did,” affirmed Nisha. 

“In my village they tell me I’m useless because I’m divorced and unable to move my neck and arms. I will now return to my village and show everyone that I’m not useless,” said Hasan while she slowly fell back asleep.

Hasan’s story has touched our entire team’s heart. Her body may have been scarred, but her character and spirit remain intact as she heads back to her village ready to prove her worth. 

Bhumi

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications 

A year ago, eight-year-old Bhumi was playing on her terrace with a stick when she accidently touched a high voltage cable. She was electrocuted and as a result, lost both her arms. Bhumi’s parents were devastated but they put aside their grief in order to help Bhumi overcome her accident. 

“We’ve taught her to use her residual limbs to write, use a cell phone and even play video games, “ shared her mother. 

Bhumi showed us how she writes and impressed everyone in the room. “ I am eight years old. I have one brother,” she wrote.  

Despite Bhumi’s resourcefulness, our surgical outreach director, Dr. Yogi Aeron, wanted to help. So, he called in a prosthetic specialist to measure Bhumi for prosthetics. She should be getting her new prosthetics this week!  

Cooking Accidents

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

For the poor in India, cooking a daily meal can become a tragedy. A significant number of women evaluated by our team for surgery suffered their burn injuries while cooking for their families.

One patient casually mentioned burns as a common occurrence in her village. “Women get burned when cooking and men get burned in factories, “ she explained. In the hospital waiting room burn patients fill every seat and spill over into hallways and empty rooms. Many of them cover their scars with shawls as if ashamed of their calamities. I asked a few patients if they knew others who have similar injuries. Everyone knew of at least two other cases in their villages.

Being here brings ReSurge’s work into perspective. It makes me proud to work for an organization that not only treats these patients but is also working to prevent future injuries.

And so, from Dehradun, India, I hope those of you who read this blog join ReSurge’s ReThink Burns campaign and advocate for the patients I am meeting and those at risk of suffering a similar fate. 

“Welcome the Patient”

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

Every morning when we arrive at the hospital, the team hits the ground running. I imagine a starting gun going off in everyone’s mind and the race begins. OR nurses prepare the instruments for the upcoming surgeries, anesthesiologists set up equipment and medications, the pediatrician rounds to evaluate the progress of the patients who received surgery the previous day and the PACU nurses organize the recovery room.   

Today, while walking by the PACU, I heard Faruk (pictured left), one of the local nurses working with us, saying “welcome the patient,” “welcome the patient,” as he folded a blanket over the hospital bed and his fellow nurse colleagues watched. He then intricately folded the blanket into a nice design. “My nursing professor taught me how to do this,” he explained. “We must welcome the patient,” he continued. I thought it was a lovely way to show our patients just how much we care for them.

I find it inspirational that this team of people who have never met the patients--some of our team members have never even set foot in India before--care so deeply about them. I hear our team members discuss cases and the best way to provide high quality surgical care. With every stitch, every bandage, every medication, they show they care. Sometimes, smaller details demonstrate that sentiment even further. The gentle pat on a worried parent’s back or a nicely folded blanket in the PACU all show that we care. Each team member, in his or her own way, in the words of Faruk, “welcomes the patient.” 

Nhan

Cao Lanh, Vietnam -- Michael Flynn, ReSurge volunteer anesthesiologist

Nhan is a one-year-old who lives with his grandmother (pictured right). He was born with a large cleft lip and palate and abandoned at birth by his father’s family. In Vietnam, if a child is born with a defect, the mother is blamed and her family has to take responsibility. Nhan was given to his maternal grandmother and has been raised by her in a very poor area on the Mekong Delta. 

Phi, pictured left, is a local volunteer helping us in Cao Lanh. She lives in Ho Chi Minh City but searches for patients for us in poor villages. Phi heard about Nhan and arranged for the child and grandmother to travel four hours by bus. They arrived on our second week here, hoping we would have space on the schedule. As we pulled up to the hospital these three smiling faces greeted us, and as luck would have it, our first case was canceled that day so we had room on our schedule.

Nhan had not eaten or had anything to drink, so it was safe to proceed with anesthesia. By 9 a.m. that same morning, Nhan had a brand new beautiful upper lip, thanks to Phil and the ReSurge team. Even better, Nhan's mother and father were also at the hospital to see him emerge a new baby. In an unprecedented show of emotion, Nhan’s grandmother hugged Dr. Ronald Worland, Nhan’s surgeon, when he came to give her the good news.

Not just Clefts and Palates

Cao Lanh, Vietnam -- Michael Flynn, ReSurge volunteer anesthesiologist

In Vietnam, parents and children wait outside the operating room for their turn for surgery. They talk to each other and support each other at this very emotional time. ReSurge’s visit is something they have been awaiting on for a long time. Two such parents (pictured right) were waiting with their children this morning.

Ptosis is a condition in which the eyelid muscles are not strong enough to open ones eyes fully. Many patients have to tilt their heads back in order to see, this was the case of the little boy pictured right. The surgery to correct this condition is very difficult. It is one of the skills that our team leader, Dr. Eric Mooney, has acquired during his years as a plastic surgeon. Dr. Mooney took a length of tendon from a muscle of the patient’s upper leg, closed that area and then placed a series of the elastic tendon in the eyelid.
The tendon now does the job of the missing eyelid muscle. Both of the patient’s eyelids underwent the surgery. The team anxiously waited for him to wake up to see if the right amount of correction had been performed. The perfect result is shown in this picture from the ward later that day.

Meanwhile, the two-year-old girl pictured left has a congenital deformity on her right hand. Her fingers are all joined together and two fingers never developed at all. Dr. Ronald Worland, the team’s other plastic surgeon, is very quickly becoming the Cao Lanh expert at saving and separating fused fingers. Dr. Worland was able to save and separate our patient’s three little finger so that she will be able to color and play just like any other child.

Our Creative PACU Nurses

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

As I was walking by the PACU today, I noticed two pieces of cardboard sitting on a bed. Upon closer inspection, I saw the words “Mary Beth’s Clipboard” and “Terri’s Clipboard” on each cardboard. It turns out our team has a creative pair of nurses who are very resourceful when they need something. A highly valuable trait when you’re working abroad with limited resources.

Making clipboards out of cardboard was just the beginning of their creativity. In the PACU, where patients come to awake from surgery, our nurses often need our patients to take deep breaths to ensure they are recovering well after anesthesia. A task few of our younger patients cooperate with. So, our nurses created a solution for that as well. Using a surgical glove, a sharpie and plastic tubing, they created a fun device where our young patients can have fun while taking deep breaths. In the picture below, PACU nurse Mary Beth is demonstrating this innovative solution.

Yet, the creativity doesn’t end there. Mary Beth designed the supply holder pictured in the background of the photo above, which her husband helped sew for the trip. Each pocket size is carefully thought out to fit specific supplies. Their creation is now hanging in the back of our PACU with all the supplies neatly organized. A big thank you to Fred (Mary Beth’s husband) for creating such a useful tool for the team!

Anjali

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

The challenges our patients face are sometimes evident in the grief they carry in their eyes. This was the case with nine-year-old Anjali. She arrived to clinic day carried in her father’s arms. As soon as we saw the burn contracture on her right leg, we understood her sadness.

Anjali was terribly burned when she was a 21-day-old baby. Like most poor families in the developing world, her family uses open fires to stay warm during the winter months. One winter, the straw cot Anjali was sleeping on caught fire, leaving her severely injured at a very young age. The burn injury Anjali sustained on her right leg caused her skin to contract, leaving her unable to user her leg. Anjali has never been able to walk.

Our surgeons will be operating Anjali’s leg to release her contracture and the occupational therapist on our team will be casting her leg to immobilize it and ensure a successful surgery result.

After surgery, Anjali will be able to walk for the first time in her life. However, our greater hope is that, with time, that distinct child-like happiness returns in her eyes. 

 

Vaishnar

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

Some children have a way of lighting up the room when they walk in. This was the case with little Vaishnar. This energetic seven-month-old smiled his way through his entire medical evaluation. Vaishnar was born with a disfigured right nostril. His family brought him to us with the hope that surgery could help. Unfortunately, at this time, our team cannot operate on little Vaishnar. However, our occupational therapist worked with his parents to teach them how to expand Vaishnar’s nostril. With time, once Vaishnar’s nostril has expanded, he will become a good candidate for surgery. 

A Unique Waiting Area

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

During clinic day patients were asked to wait in the gazebo pictured above. This beautiful open space was quickly turned into our younger patients' playground. They spent the afternoon in the sun chasing one another before our medical team evaluated them. 

Dr. Yogi Aeron, our surgical outreach director, informed us that he often allows poor families in the area to borrow the gazebo free of charge so they have a space to celebrate weddings--making this waiting area not only beautiful but truly unique. 

Namaste Walk

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

Tucked away in the foothills of the Himalayas lies ReSurge’s surgical outreach program in Dehradun. Today, our team arrived ready to evaluate nearly 100 patients for surgery. As we walked up the hill to our work area for the day, a long line of patients lined the road to welcome us, each saying “Namaste” as we walked by. Every member of our team quickly joined in saying it back. With every step, a new “Namaste” was said and with this peaceful greeting, our work in Dehradun began. 

Meet the Dehradun Team

Dehradun, India – Liliana Vazquez Giffen, ReSurge associate director of marketing and communications

After traveling for more than 48 hours, we finally arrived in Dehradun, India. We have an outstanding team of veteran volunteers who arrived tired but enthusiastic for the work ahead.

Our team is composed of two plastic surgeons, three anesthesiologists, a pediatrician, a nutritionist, an occupational therapist, two OR nurses, two PACU nurses and two coordinator/translators. In line with ReSurge’s goal to build medical capacity, five local nurses are joining us to work with and learn from our team.

This is the fifth time I’ve had the opportunity to join a ReSurge surgical team. I feel incredibly fortunate for the unique opportunity of witnessing humanity at its finest. Through this blog, I’ll be sharing details about our trip including who we meet, what we see and most importantly, whose lives our volunteers help change.

Our Hospital Family

Cao Lanh, Vietnam -- Michael Flynn, ReSurge volunteer anesthesiologist

The Cao Lanh team just has completed its third surgical day with great success. The team has magically coming together in one cohesive group, and complete strangers are starting to anticipate each other during the surgical process. We also feel as though we are part of a large hospital family. Each morning our pre- and post-operative patients and parents greet us enthusiastically and the other children wave and gaze in amazement at these funny looking people. Our patients mainly have been children with cleft lips and palates, but also a surprising number of children who were born with fused fingers. Two of them are pictured above and their favorite thing to do is to crayon the coloring books ReSurge sent. The operation to release fused fingers is in fact very complicated. The hand has to be restored to full function and there are abnormal finger bones that have to be separated. Our surgeons were not expecting so many, but are masterfully addressing them.